Provider Demographics
NPI:1295473544
Name:MADDEN, KARISSA (NP)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:MADDEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2209 GENESEE ST
Mailing Address - Street 2:BUSINESS OFFICE ROOM 315
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502
Mailing Address - Country:US
Mailing Address - Phone:315-801-8534
Mailing Address - Fax:315-801-8391
Practice Address - Street 1:3946 ONEIDA ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-9702
Practice Address - Country:US
Practice Address - Phone:315-624-8300
Practice Address - Fax:315-624-8310
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-09-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY735329163W00000X
NY350074363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse